Most people know that confidentiality, boundaries, and self-care are important considerations when caring for others. But there is some confusion about what these words actually mean and how they apply to bikkur holim. In this unit we will define and explore these terms.
Confidentialty means “that data or information is not made available or disclosed to unauthorized persons or processes,” according to the Health Insurance Portability and Accountability Act (HIPAA) of 1996.It is important for every community to have clear guidelines about congregant confidentiality and privacy. Volunteers might inadvertently become privy to sensitive physical or mental health information. The person you are interacting with may confide in you, or you may learn something from neighbors or members of the household. You may witness something while in the home or facility where the person is being cared for.
Regardless of how this information becomes known, bikkur holim volunteers need clear guidelines about to whom they should disclose information (for example, the chair of the bikkur holim committee, the rabbi of the congregation), especially if they feel the person they are visiting is a danger to themselves or others.
|Does your community have clear confidentiality and privacy guidelines for bikkur holim? If not, take a few moments to brainstorm what you think might be important points for such a policy and how this information will be conveyed to volunteers.|
Boundaries are the rules (sometimes unstated) that distinguish acceptable from unacceptable behavior; they negotiate closeness and distance in relationships. Awareness of boundaries and how they work is particularly important in bikkur holim because of the unique intimacy of visiting or speaking with someone in their homes or during a time of illness. It can be unclear where the lines are in these relationships and contexts, because you are literally crossing the threshold into people’s private spaces. Although boundaries are often referred to as “good or bad,” a more helpful paradigm is to evaluate boundaries based on whether they are clear and flexible versus rigid and enmeshed. If our boundaries are clear to us, we can help those we are caring for have a better idea of what to expect from our relationship. Flexible boundaries are important, because rigid ones are often unrealistic; they tend to be brittler and to be broken more easily. We can’t predict what will happen in every situation; we need to leave some room to adapt based on how things change.
Boundaries help us to monitor how we enter and interact in another person’s personal life. They also help guide us about how much we disclose about our own selves. In religious communities, you and the person you are caring for may already know things about each other that you wouldn’t in another context. For example, the person you are visiting may know that you have children and may ask you about them when you visit.
Each volunteer can use discretion about what to share, how much, and when. Here are a few tips about deciding how much to share:
- Ask yourself: Would I feel upset if this person shared the information I am disclosing with someone else?
- Ask yourself: Does it seem like sharing a little bit about myself may help build trust and rapport with this person, and help the person feel better understood and less lonely?
- Consider the timing and why you feel compelled to share at this moment. Are you feeling anxious about filling a silence or making someone feel better?
- Even if you have had an experience that you think is similar to that of the person you are visiting, consider how you can empathize with what they are sharing, rather than directly telling them about your experience.
- When you do decide to disclose something about yourself, keep it very brief: stick to one or two sentences at the most.
Boundaries are also sometimes negotiated through emotional triangles. The following excerpt illustrates a triangle in a relationship.
A student once came with a complaint about her husband’s dog that caused conflict in their marriage. She indicated that though she doesn’t especially like dogs, she accepted her husband’s dog as a “price” she was willing to pay to be married to him. Now however, he was working long hours to support them and was often away from home in the evening. Although she understood that he needed to make extra money to support them, she was becoming resentful of the fact that she had to care for his dog in his absence. On top of this, when her husband returned home late, the dog rushed to greet him and he would fondle the dog affectionately before he got around to greeting her. The triangulating party here was the dog, and the fact that her husband’s relationship to him preceded his relationship to her contributed to her resentment. She didn’t feel that she should issue an ultimatum, “Either he goes, or I go,” because she realized . . . she was beginning to treat the dog rather harshly.
. . . This illustration supports an aphorism that I have found rather useful over the years, that “Triangles come in pairs.” Behind the husband-wife-dog triangle lies the husband-wife-work triangle.
—Donald Capps, Giving Counsel: A Minister’s Guidebook[i]
Have you ever had the feeling that someone is pulling you into a relationship with a third party that has nothing or little to do with you? We are all susceptible to triangulating with a third party at one time or another as a way of alleviating our discomfort and anxiety about a conflict and to avoid dealing with it head-on. Emotional triangles are not inherently bad. And finding yourself in a triangle doesn’t mean your boundaries are “bad.” The most important thing is what you do when you realize you are in a triangle. As a volunteer you should be aware of when you are being drawn into the triangle. Try to establish direct relationships with each party involved, and stay out of being drawn into their relationships with each other.
Bikkur holim volunteers will encounter many challenging situations and experiences. Witnessing the impact of an illness on someone’s mind, body, spirit, and relationships can be difficult, so bikkur holim volunteers need to practice self-care. Some people believe that the best way to do self-care is by pampering themselves. Although it’s great to take extra good care of yourself, one of the most effective ways to do so is to know and respect your own boundaries.
[i] Donald Capps, Giving Counsel: A Minister’s Guidebook. (St. Louis: Chalice Press, 2001), 119.
|Unit 7: Shema Koli: Communication Skills||Unit 9: Praying for Healing|